DECLARATION OF ULTIMATE BENEFICIAL

OWNERSHIP (UBO)

PART 1: CLIENT DETAILS

Registered Name _______________________________________________Registration No. _______________________

Client Address ______________________________________________________________________________________

PART 2: LISTED COMPANY

(i) I/We hereby declare that (Please tick the appropriate box)

Our company is listed on a recognized stock exchange Our company is a subsidiary of the listed company.

Our company is controlled by a listed company. If none of the above, please complete Part 3

(ii) Details of Listed Company

Company full name, as listed _________________________________________________________________________

Stock Exchange on which company is listed _______________________________________________________________

PART 3: INDIVIDUALS OR ENTITIES OTHER THAN LISTED COMPANY

I/We hereby declare that (Please tick the appropriate box)

Subsidiary of Listed Company (please ensure Part 2 is completed stating the listed company)

Private Company Trust LLP Others (please specify)

PART 4: INFORMATION PERTAINING TO INDIVIDUALS OR ENTITIES OTHER THAN LISTED COMPANY

Please complete in accordance with the information provided in Part 3. (Please tick the appropriate box)

UBO No. Relationship Tick

1 Controlling ownership interest of 10% or more of shares of the corporate vehicle, where the
controlling ownership is held by a corporate vehicle.

2 Controlling ownership interest of 10% or more of shares of UBO-1 is held by a subsidiary corporate
vehicle (inclusive of independent corporate vehicles investing in UBO-1).

3 Controlling ownership interest of 10% or more of shares of UBO-1 or UBO-2 (depending on corporate
vehicle’s structure), where the controlling ownership is held by such a company.

4 Natural person exercising control over the corporate vehicle through other means exercised through
voting rights, agreement, arrangements or in any other manner (in cases where there exists doubt
under UBO-1 to UBO-3 above as to whether the person with the controlling ownership interest is the
beneficial owner or where no natural person exerts control through ownership interests).
5 Natural person who holds the position of senior managing official (in case no natural person can be
identified as above).

6 Trustee(s) of a Trust.

7 The beneficiaries with 10% or more interest in the Trust if they are natural person(s).

8 Natural person(s) exercising ultimate effective control over the Trust.

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 UBO Full Names Nationality Identification Country of Date of Birth KRA PIN Occupation Country of Physical PEP Designation % Ownership, Signatory
No. (ies) Document Issuing Residence Address (YES/ (Shareholder, Voting Rights, (YES/

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(Passport, NO) Director, Partner, Controlling NO)
National ID, Beneficial owner, Interest)
Registration/ Agent,
Trust) Power of Attorney
etc)

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6

Note: 1. If more rows are needed to complete UBO information, client to submit multiple declarations.
2. If information pertains to other relevant stakeholders who may not necessarily be UBOs e.g. appointed/authorized signatories, please indicate a (-).

DECLARATION
I/We acknowledge and confirm that the information provided above is/are true and correct to the best of my/our knowledge and belief. In case any of the above specified
information is found to be false/untrue/misleading/misrepresenting and/or the declaration is not provided, I acknowledge that Equity Bank (Kenya) Limited reserves the right
to reject the application or to apply enhanced due diligence procedure/measures relating to the information pertaining to the company and the UBO of the company, upon
after such procedures, Equity Bank (Kenya) Limited may opt to discontinue existing business relationship with the company. I/We also undertake to keep Equity Bank (Kenya)
Limited informed in writing about any modification/ changes to the above information in future and also to provide any other additional information as may be required by them.
 I/We confirm I/we have read and understood the terms of the Privacy Policy and hereby give express, unequivocal, free,
specific and informed authority to Equity Bank (Kenya) Limited and its affiliates to collect, use and process my/our data as
per the policy provided at https://equitygroupholdings.com/privacy-policy/

AUTHORISED SIGNATORIES

Name _____________________________ _______________________________ ___________________________________

(Surname) (First Name) (Middle Name)

Signature_______________________________ Capacity__________________________ Date ________________________

Location_________________________________ (DD/MM/YYYY)

Name _____________________________ _______________________________ ___________________________________

(Surname) (First Name) (Middle Name)

Signature_______________________________ Capacity__________________________ Date ________________________

Location_________________________________

Name _____________________________ _______________________________ ___________________________________

(Surname) (First Name) (Middle Name)

Signature_______________________________ Capacity__________________________ Date ________________________

Location_________________________________

GENERAL INFORMATION AND INSTRUCTIONS PERTAINING TO AN UBO

As per the Proceeds of Crime and Anti Money Laundering Act, and related subsidiary legislation issued on the said Act regarding Customer
Due Diligence procedure on the prevention of money laundering, accountable institutions should readily ascertain the ultimate beneficial
owner of corporate vehicles and trusts. These parties are required to provide details of its ultimate beneficial owner to ease over the process
and to continue their relationship with such an institution. In accordance with FATF regulations, an UBO has been defined as the natural
person(s) who ultimately own, control or influence a client and/or persons on whose behalf a transaction is being conducted and includes a
person who exercises ultimate effective control over a legal person or similar arrangement.
Ultimate Beneficial Owner (UBO):
1.For all corporate vehicles:
i. The identity of the natural person, who, whether acting alone or together, or through one or more corporate vehicle(s), exercises
control through ownership or who ultimately has a controlling ownership interest. Controlling ownership interest means ownership of
entitlement to: - more than 10% of shareholding of the corporate vehicle, where the juridical person is a company;
ii. In cases where there exists doubt under clause (i) above as to whether the person with the controlling ownership interest is the beneficial
owner or where no natural person exerts control through ownership interests, the identity of the natural person exercising control over
the corporate vehicle through other means, in example, voting rights, agreement, arrangements or in any other manner.
iii. Where no natural person is identified under clauses (i) or (ii) above, the identity of the relevant natural person who holds the position of
senior managing official.
2.For Trusts
The identity of the founder of the trust, the trustee, the beneficiaries with 10% or more interest in the trust and any other natural person
exercising ultimate effective control over the trust.
3.Exemption in case of listed companies
The client or the owner of the controlling interest is a company listed on a recognised stock exchange, it is not necessary to identify and verify
the identity of any shareholder or beneficial owner of such companies.
4.KYC Requirement
Beneficial owner(s) is/are required to comply with the prescribed KYC process as stipulated within Equity Bank (Kenya) Limited’s KYC
policies.
5.UBO Number, as defined by Equity Bank (Kenya) Limited, to be inserted in Part IV of the declaration above.

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